The association between protein binding property of antibiotic and the prediction of 28-day mortality & length of stay for hypoalbuminemia patients

Abstract

INTRODUCTION: Infections are commonly seen these days in every ER. Not recognizing an infection may lead to a more sinister issue known as sepsis. Along with it, more are seen with hypoalbuminemia and the study of its implication has been very limited. According to the Surviving sepsis Campaign, antibiotic should be served within an hour once an infection it is recognized. Generally, there two groups of antibiotics, high bound and low bound group and research on this in hypoalbuminemia patients is very limited. The objective of this study is to determine the association of the type of protein bound antibiotic prescribe Emergency Department and mortality in patient with sepsis. METHODS: A retrospective review of medical records of 168 patients attended at the Emergency Department of HCTM, was performed. The review included patients aged 12 and above, who were diagnosed with any infection and had albumin counts less than 30 upon treatment from January 2019 till December 2019. Review of the type of antibiotic prescribed was made and each patient's 28 days outcome was documented. This study was also done to determine if the length of admission had any association to the type of antibiotic prescribed. RESULTS: A total of 168 patients were included in this study (n=168) [ 77 female (n=45.8%) and 91 males (n=54.2%)]. Of this, 125 patients were prescribed with low-protein-binding-antibiotics and 43 were prescribed high- protein-binding-antibiotic. In terms of mortality, the patients whom received low-protein- binding-antibiotic showed to have better 28 days outcome with a significant p value of 0.05. In term of length of stay, showed no significance between these two types of antibiotics, as the p value was 0.63. CONCLUSION: According to this study, the usage of low-protein-binding- antibiotics in hypoalbuminemia patient has shown to have greater impact in improving mortality. Despite lack of data in improving the length of stay, but the overall improvement in mortality shows there is association between mortality and type of protein-binding-antibiotic that is prescribed. KEYWORDS Infection, Sepsis, Hypoalbuminemia, Low-protein-binding-antibiotic, High-protein-binding- antibiotic, Mortality.